2006 ONS Congress Webcast Evaluation Form Balancing Evidence and Clinical Practice in the Treatment of Localized Breast Cancer Session length: 1 hour, 49 minutes Contact hours: 1.6 Pharmacology hours offered: 15 minutes How to obtain CE credit: 1. Register and provide payment information. a. There is a $15 processing fee for this program. b. This program is offered for FREE to individuals who paid the FULL registration fee for the 2006 Congress. 2. Complete the session Evaluation including the Impact on Practice Section. 3. Return this form to ONS. a. Via FAX using the attached FAX cover sheet to: 412-859-6160. b. Via e-mail: EducationCourses@ons.org. c. Or mail to: Oncology Nursing Society P.O. Box 3510 Pittsburgh, PA 15230-3510 Registration Information Name: Credentials: Street Address: City: State: Zip: Telephone: ( ) Fax: ( ) ONS#: Email address: Credit card type: MasterCard Visa Name on card (if different from above): Credit card number: Expiration date: To receive CE credit for this virtual session, please listen to and view the entire webcast. You must submit this evaluation form to receive a CE certificate for this program. Verification of your CE credit will be mailed to you. Certificates will be mailed within six weeks following receipt of your completed and approved evaluation form.
DEMOGRAPHIC DATA: 1. How many years of oncology nursing experience do you have? 2. Are you an ONS member? Yes (If yes, proceed to question 6) No 3. Primary Position (select one) Academic Educator Director/Assistant Director/VP Pharmaceutical Representative Case Manager Genetic Counselor Researcher/Principal Investigator Clinical Nurse Specialist Nurse Manager/Coordinator Staff Development Consultant Nurse Practitioner Staff Nurse Clinical Trials Nurse Patient Educator 4. Primary Work Setting (select one) Inpatient: Bone Marrow Transplant Unit Intensive Care Unit Medical/Surgical Unit General Outpatient: Home Care Hospice Hospital-based Clinic Corporate/Industry Extended-Care Facility HMO/Managed Care 5. Primary Specialty Biotherapy/Chemotherapy Bone Marrow transplant Palliative Care Prevention/Detection Medical/Surgical Unit - Oncology Oncology specialty unit Physician Office Radiation School of Nursing Self-Employed Radiation Oncology Surgical Oncology 6. What is the percentage of patients you care for who have an oncology diagnosis? 0% 25% 50% 75% 100% 7. What types of cancers/disorders do you work with most frequently? Breast Cancer Brain Cancer Colon and Rectum Cancer Head and Neck Cancers Hematologic Disorders HIV/AIDS Leukemia Lung and Bronchus Cancer Melanoma Non-Hodgkin s Lymphoma Prostate Cancer Urinary Bladder Cancer 8. Do you have prescriptive privileges for? (Circle all that apply) Oral Medications IV Chemotherapy IV Medications Controlled substances Oral Chemotherapy
EVALUATION QUESTIONS Please check the numbers that best describes your evaluation of the following items: 1 = Not at all 2 = Low 3 =Medium 4 = High 9. To what degree did you achieve the following objectives? 1 2 3 4 Objective 1: Analyze the evidence for the extent of breast surgery and use of sentinel lymph node biopsy for DCIS. Objective 2: Compare the benefit/risk ratios of full, partial, or no radiation therapy for DCIS as well as risk-reduction precautions for lymphedema. Objective 3: Apply existing research evidence and clinical understanding to supporting patients decision-making processes and self-management behaviors. 10. Rate the teaching effectiveness of each speaker (i.e., quality of presentation, reference to current evidence and application to clinical practice): Speaker 1 Deena Dell, MSN, RN, AOCN, BC Speaker 2 Jane Armer, RN, PhD Speaker 3 Deborah Hamolsky, RN, MS 13. Was this educational activity free of commercial bias: Yes No If no, why? 14. To what extent do you agree that this program was presented at a level appropriate to you knowledge and experience? 15. What is the primary reason you participated in this CE activity? I need CE credit for licensure I need CE credit for ONC-PRO The topic is important to me The speakers are well-known 16. How will you modify your practice as a result of this program? (check all that apply) Improve skills for patient counseling Improve skills for discussing treatment options with patients Enhance ability to discuss treatment options with multi-disciplinary care team Enhance ability to educate colleagues Improve ability to apply evidence to patient care 17. Which of the following topics do you consider your educational priorities? (Choose up to 3) Chemotherapy Gynecologic cancer Vascular access devices
Genetics Leukemias/Lymphomas Prevention early detection Radiation therapy Head and neck cancer Complimentary & alternative medicine Safe handling Lung cancer Hematologic toxicities Survivorship Pancreatic cancer Nutrition in cancer Oral mucositis Brain cancer Geriatric oncology End of life Skin cancer Pediatric Oncology Nursing Society CINV Urinary/bladder cancer Leadership development Breast cancer Infusion reactions Interpreting data to apply to practice Prostate cancer Pain management Stress management for healthcare professionals Colorectal cancer Targeted agents 18. How did you learn about this CE program? Direct mail to home or office A colleague or friend ONS Website Congress/IOL E-mail announcement CE Central ONS News ONS e-news Comments and suggestions for improvements:
Oncology Nursing Society 125 Enterprise Drive Pittsburgh, PA 15275 Facsimile Monday, June 26, 2006 To: Oncology Nursing Society Education Team P.O. Box 3510 From: Phone: 1-866-257-4ONS Phone: ( ) Fax: 412-859-6160 Fax: ( ) RE: Instructional 15 Evaluation: Balancing Evidence and Clinical Practice in the Treatment of Localized Breast Cancer Comments: Pages: 5 (including cover)